Healthcare Provider Details

I. General information

NPI: 1245797570
Provider Name (Legal Business Name): LHCG CXLIII, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201B N CHURCH ST STE 403
HAZLE TOWNSHIP PA
18202-1455
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 570-450-4050
  • Fax: 570-450-4051
Mailing address:
  • Phone: 337-233-1307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1037436480001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. NICHOLAS GACHASSIN III
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 337-233-1307